HomeMy WebLinkAbout2003-01-30 - Agendas - FinalFIRMEN'S PENSION AND RELIEF FUND
AGENDA
JANUARY 30, 2003
A meeting of the Fayetteville Firemen's Pension and Relief Fund Board will be held on
January 30, 2003, at 11:00 a.m. in Room 326 of the City Administration Building located
at 113 West Mountain Street, Fayetteville, Arkansas.
1. Approval of the Minutes
2. Approval of the Pension list.
1. Teddy O'Neal +.a. �j_
2. Joey Pierce
3. Glen Shackelford
4. Marshall Mahan
3. Investment Report.
4. Other Business
•
MINUTES OF A MEETING
OF THE
FIREMEN'S PENSION AND RELIEF FUND BOARD
DECEMBER 26, 2002
A meeting of the Fayetteville Firemen's Pension and Relief Fund Board was held on
December 26, 2002 at 11:00 a.m. in Room 326 of the City Administration Building
located at 113 West Mountain Street, Fayetteville, Arkansas.
PRESENT: Ronnie Wood, Pete Reagan, Danny Farrar, Marion Doss, Robert Johnson,
Heather Woodruff, and Kit Williams.
MINUTES
Mr. Reagan moved to approve the minutes.
PENSION LIST
Mr. Doss stated Ralph Tate had been moved from Drop to retirement status.
Mr. Reagan moved to approve the pension list. Mr. Johnson seconded. The motion
carried unanimously.
INVESTMENT REPORT
Mr. Reagan stated Longer Investments would not be able to make this meeting, but they
had dropped off a summary. They had asked if they could do a quick overview every
month, then a detailed once every quarter.
OTHER BUSINESS
Ms. Stout had sent the Pension Board a check for $300.00. The board agreed the check
needed to be deposited into the fund.
Mr. Williams stated they had received two replies to their RF
The board reviewed the responses
Mr. Farrar moved that they select Mr. Stutte. Mr. Reagan seconded. The motion carried
unanimously.
Mr. Williams stated he would work out an agreement with them in regards to fees and
bring it back to the board. He also wanted to make sure that they were representing the
board and not individuals in the pension fund.
The meeting adjourned 11:50 a.m..
FIREMEN'S RELIEF AND PENSION
JANUARY 2003
,T FOLLOWING ARE THE OBLIGATIONS OF THE FIREMEN'S RELIEF FUND FOR THE
H OF JANUARY 2003. YOU ARE HEREBY INSTRUCTED TO ISSUE CHECKS TO THE
t, ES, IN THE AMOUNTS SHOWN, AND FOR THE PURPOSE SO STATED
DATE OF REGULAR Year To Date
EMPlRETIREMENT NAME
MO BENEFIT REG BENEFIT FED. TAX ST. TAX NET
79 11/99 ARMSTRONG (DILL), PAMELA 1,658.91 0.00 300.00 100.00 1,258.91
74 3/86 BAIRD, JULIA 1,649.16 0.00 550.00 145.00 954.16
2 3/75 BLACKARD, PAUL 55.00 0.00 55.00
63 5/72 BOLAIN, ANN 55.00 0.00. 55.00 '
68 7/99 BONADUCE, MICHAEL 2,735.14 0.00 475.38 2,259.76
44 9/86 BOUDREY, BETTY MRS. 2,267.18 0.00 300.00 50.00 1,917.18
45 9/86 BOUDREY, HOWARD 1,911.99 0.00 1,911.99
49 7/88 BOUDREY, JACK 1,507.82 0.00 287.68 50.00 1,170.14
4 6167 CARL, FLOYD JR 55.00 0.00 55.00
5 5/72 CASELMAN, ARTHUR 75.00 0.00 75.00
57 5/90 CATE, ROY 1,637.10 0.00 1,637.10
6 4/68 CHRISTIE, ARNOLD 55.00 0.00 55.00
84 03/01 CIRCT CLRK WA CO .0.00 0.00
85 03/01 CIRCT CLRK WA CO 0.00 0.00
.8 10/76 COUNTS, WAYNE - 55.00 0.00 55.00
61 6/66 DAVIS, BEULAH F. 377.50 0.00 377.50
78 11/99 DILL,GARY JOHN 1,658.92 0.00 100.00 1,558.92
11 2/76 FARRAR,ALONZO 914.10 0.00 75.00 839.10
38 5/84 FRALEY, JOSEPH G. 1,618.08 0.00 200.00 15.00 1,403.08
92 03/02 GAGE,TOMMY 2,37634 0.00 226.00 50.00 2,100.34
34 6/79 HARRIS, JAMES E. 55.00 0.00 55.00.
70 11/99 HARRIS, MARY RUTH 55.00 0.00 - 55.00
93 06/02 JENKINS, JOHN 3,273.93 0.00 700.00 200.00 2,373.93
86 07/01 JOHNSON,ROBERT 2,812.66 0.00 500.00 .100.00 2212.66
• 64 4/95 JORDAN, CHARLIE 2,081.90 0.00 2,081.90
76 5/88 JUDY, JAN 1,507.82 0.00 200.00 50.00 1,257.82
37 3/84 KING, ARNOLD D 1,393.18 0.00 300.00 200.00 893.18
54 5/89 KING, ARVIL 1,566.00 0.00 130.00 1,436.00
12 3/60 LANE, HOPE MRS 55.00 0.00 55.00
13 10/67 . LAYER, MERLIN 417.50 0.00 - 417.50
14 7/74 LEE, HAROLD 55.00 0.00 55.00
51 10/88 LEWIS CHARLES 1,50782 0.00 75.00 25.00 1,407.82
55 12/89 LEWIS ROGER (DECEASED) 0:00 0.00
40 9/85 LOGUE, PAUL D. 2,624.88 0.00 325.00 75.00 2,224.88
50 9/88 MASON, LARRY 1,492.83 0.00 78.16 1,414.67
39 4/85 MC ARTHUR, RONALD A. 1,604.92 0.00 150.00 50.00 1,404.92 .
35 2/82 MC CHRISTIAN, DWAYNE 55.00 0.00 55.00
15 4/77 MC WHORTER, CHARLES 1,221.26 0.00 150.00 1,071.26
29 8/81 MILLER, DONALD 1,193.41 0.00 125.00 25.00 1,043.41
73 2/00 MILLER,KENNETH 2,910.17 0.00 2,910.17
42 2/86 MOORE, JAMES H. " 55.00 0.00 55.00
17 2/66 MORRIS, WILKIE MRS. 55.00 0.00 55.00
16 4/64 MORRIS, WILLIAM H. 70.00 0.00 70.00
62 10/68 . MORRISON, ELIENE 80.00 0.00 80.00
48 7/88 MULLENS, DENNIS W. 2,005.35 0.00 2,005.35
58 9/90 OSBURN, EDWARD 2,248.33 0.00 160.00 2,088.33 •
46 5/88 OSBURN, TROY 1,738.46 0.00 200.00 38.00 1,500.46
81 02/01 PHILLIPS,LARRY 2,530.45 0.00 2,530.45
53 2/89 POAGE, LARRY 2,147.56 0.00 300.00 100.00 1,747.56
22 4/73 REED, JOE . 55.00 0.00 55.00
30 3/81 SCHADER, EARVEL 1,268.40 0.00 1,268.40
• 41 9/85 SCHADER, TROY 1,395.58 0.00 57.00 1,338.58
82' 03/01 SKELTON,KELLY 1,114.17 0.00 125.00 25.00 964.17
83 03/01 SKELTON, KIMBERLY 1,114.17 0.00 125.00 25.00 964.17
•23 4/71 SKELTON, LAWRENCE BURL . 870.50 0.00 870.50
66 8/98 SKELTON, PAULINE 390.00 0.00 390.00
36 5/76 SPRINGSTON, CARL 737.78 0.00 70.00 17.00 650.78
90 03/02 STOUT, IMOGENE W. 702.65 0.00 702.65
25 " 2/75 STOUT, ORVILLE (DECEASED) 0.00 0.00
165 12/02 TATE, RALPH 3,356.83 0.00 300.00 100.00 2,956.83
26 3/66 TUNE, BILLIE SUE 80.00 0.00 80.00
FIREMEN'S RELIEF AND PENSION
JANUARY 2003
DATE OF
•MP# RETIREMENT
NAME
27 3/71 TUNE, MILDRED MRS.
71 1/00 WARFORD,THOMAS
28 7/68 WATTS, DONALD
59 5/91 WATTS, WAYNE (DECEASED)
88 01/02 WOOD,RONNIE D
52 9/88 WRIGHT, RANDALL
DROP DATE
05/01/98
02/01/99
05/01/99
04/01/00
07/01/00
01/01/01
DROP EMPLOYEES
FREEDLE, LARRY
LEDBETTER, DENNIS
BACHMAN, EDDIE
NAPIER,LONNIE
REAGAN,PETE
DOSS,MARION
REGULAR Year To Date
MO BENEFIT REG BENEFIT FED. TAX ST. TAX
80.00
2,290.35
400.00
2,816.02
1,547.82
75,694.94
0.00
0.00 300.00
0.00
0.00
0.00
0.00 200.00
0.00 7,084.22
25.00
1,465.00
NET
80.00
1,990.35
400.00
0.00
2,816.02
1,322.82
67,145.72
NEW BENEFITS
3,492.86
3,455.40
2,396.34
3,219.73
3,235.68
4,920.63
WE, THE UNDERSIGNED, DO SOLEMNLY SWEAR THAT THE ABOVE OBLIGATIONS ARE
JUST AND CORRECT THAT NO PART THEREOF HAS BEEN PREVIOUSLY PAID; THAT
THE PENSION PAYMENTS SO CHARGED ARE IN ACCORDANCE WITH THE ACTIONS OF
THE BOARD OF TRUSTEES OF THE FIREMEN'S RELIEF AND PENSION FUND; THAT
THE SERVICES OR SUPPLIES FURNISHED, AS THE CASE MAY BE, WERE ACTUALLY
RENDERED OR FURNISHED; AND THAT THE CHARGES MADE THEREFORE DO NOT
EXCEED THE AMOUNT ALLOWED BY LAW OR THE CUSTOMARY CHARGE FOR SIMILAR
SERVICES OR SUPPLIES
AY CHAIRMAN AND PRESIDENT
ACKNOWLEDGEMENT
STATE OF ARKANSAS )
COUNTY OF WASHINGTON)
SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF 2003.
NOTARY PUBLIC
MY COMMISSION EXPIRES :
YTD
6810-98145335-00 0.00
•
FIREMEN'S RELIEF AND PENSION
FEBRUARY 2003
ETH FOLLOWING ARE THE OBLIGATIONS OF THE FIREMEN'S RELIEF FUND FOR THE
H OF FEBRUARY 2003. YOU ARE HEREBY INSTRUCTED TO ISSUE CHECKS TO THE
, ES, IN THE AMOUNTS SHOWN, AND FOR THE PURPOSE SO STATED
DATE OF REGULAR Year To Date
• EMP#RETIREMENT NAME
79 11/99 ARMSTRONG (DILL), PAMELA
74 3/86 BAIRD, JULIA
2 3/75 BLACKARD, PAUL
63 5/72 BOLAIN, ANN
68 7/99 BONADUCE, MICHAEL
44 9/86 BOUDREY, BETTY MRS.
45 9/86. BOUDREY, HOWARD
49 7/88 BOUDREY, JACK
4 6/67 CARL, FLOYD JR
5 5/72 CASELMAN, ARTHUR
57 5/90 CATE, ROY
6 4/68 CHRISTIE, ARNOLD
84 03101 CIRCT CLRK WA CO •
85 03/01 CIRCT CLRK WA CO
8 10/76 COUNTS, WAYNE
61 6/66 DAVIS, BEULAH F.
78 11/99 DILL,GARY JOHN
11 2/76 FARRAR,ALONZO
38 5/84 FRALEY, JOSEPH G.
92 03/02 GAGE,TOMMY
34 6/79 HARRIS, JAMES E.
70 11/99 HARRIS, MARY RUTH
93 06/02 JENKINS, JOHN
86 07/01 JOHNSON,ROBERT
• 64 4/95 JORDAN, CHARLIE
76 . 5/88 JUDY, JAN
37 3/84 KING, ARNOLD D.
54 5/89 KING, ARVIL
12 3/60 LANE, HOPE MRS
13 10/67 LAYER, MERLIN
14 7/74 LEE, HAROLD
51 10/88 .LEWIS, CHARLES
55 12/89 LEWIS, ROGER (DECEASED)
40 9/85 LOGUE, PAUL D.
50 9/88 MASON, LARRY
39 4/85 MC ARTHUR, RONALD A.
35 2/82 MC CHRISTIAN, DWAYNE
15 4/77 MC WHORTER, CHARLES
29 8/81 - MILLER, DONALD
73 2/00 MILLER,KENNETH
42 2/86 MOORE, JAMES H.
17 2/66 MORRIS, WILKIE MRS.
16 4/64 MORRIS, WILLIAM H.
62 10/68 MORRISON, ELIENE
48 7/88 MULLENS, DENNIS W.
58 9/90 OSBURN, EDWARD
46 5/88. OSBURN, TROY
81 02/01 PHILLIPS,LARRY
53 2/89 POAGE, LARRY
22 4/73 REED, JOE
30 3/81 SCHADER, EARVEL
41 9/85 SCHADER, TROY
82 03/01 SKELTON,KELLY
83 03/01 SKELTON,KIMBERLY
•23 4/71 SKELTON, LAWRENCE BURL
66 8/98 SKELTON, PAULINE
36 5/76 SPRINGSTON, CARL
90 03/02 STOUT, IMOGENE W.
25 2(75 STOUT, ORVILLE (DECEASED)
165. 12/02 TATE, RALPH
26 3/66 TUNE, BILLIE SUE
MO BENEFIT REG BENEFIT ' FED. TAX ST. TAX NET
1,658.91 0.00
1,649.16 0.00
• 55.00 0.00
55.00 0.00
2,735.14 0.00
2,267.18 0.00
1,911.99 0.00
1,507.82 0.00
55.00 0.00
75.00 .0.00
1,637.10 0.00
55.00 0.00
0.00
0.00
55.00 0.00
377.50 0.00
1,658.92 0.00
914.10 0.00
1,618.08 0.00
2,376.34 0.00
55.00 0.00
55.00 0.00
3,273.93 0.00
2,812.66 0.00
2,081.90 0.00
1,507.82 0.00
1,393.18 0.00
1,566.00 0.00
55.00' 0.00
417.50 0.00
55.00 0.00
1,507.82 0.00
0.00
2,624.88 0.00
1,492.83 0.00
1,604.92 0.00
55.00 0.00
1,221.26 0.00
1,193.41 - 0.00
2,910.17 - 0.00
55.00 0.00
55.00 0.00
70.00 0.00
80.00 0.00
2,005.35 0.00
2,248.33 0.00
1,738.46 0.00
2,530.45 0.00
2,147.56 0.00
55.00 0.00
1,268.40 - 0.00
1,395.58 0:00
1,114.17 0.00
1,114.17 0.00
870.50 0.00
390.00 0.00
737.78 0.00
702.65 0.00
0.00
3,356.83 0.00
80.00 0.00
300.00 100.00 1,258.91
550.00 145.00 954.16
55.00
55.00
475.38 2,259.76
300.00 50.00 1,917.18
1,911.99
287.68 50.00 1,170.14
55.00
75.00
1,637.10
55.00
0.00
0.00
55.00
377.50
100.00 1,558.92
75.00 839.10
200.00 15.00 1,403.08
226.00 50.00 2,100.34
55.00
55.00
700.00 200.00 2,373.93
500.00 • 100.00 2,212.66
2,081.90
200.00 50.00 1,257.82
300.00 . 200.00 893.18
130.00 1;436.00
55.00'
417.50
55.00
75.00 25.00 1 407 82
0.00
325.00 75.00 2,224.88
78.16 . 1,414.67
150.00 50.00 1,404.92
55.00
150.00 1,071.26
125.00 25.00 1,043.41
2,910.17
55.00
55.00
70.00
80.00
2,005.35
160.00 2,088.33
200.00 38.00 1,500.46
2,530 45
300.00 100.00 1,747.56
55.00
1,268.40
57.00 1,338.58
125.00 25.00 964.17
125.00 25.00 964.17
870.50
390.00
70.00 • 17.00 650.78
702.65
0.00
300.00 • 100.00 2,956.83
80.00
FIREMEN'S RELIEF AND PENSION
FEBRUARY 2003
DATE OF
•MP#RETIREMENT NAME
1 27 3/71 TUNE, MILDRED MRS.
71 1/00 WARFORD,THOMAS
28 7/68 WATTS, DONALD
59 5/91 WATTS, WAYNE (DECEASED)
• 88 01/02 WOOD,RONNIE D
52 9/88 ' WRIGHT, RANDALL •
DROP DATE
05/01/98
02/01/99
05/01/99
04/01/00
07/01/00
01/01/01
DROP EMPLOYEES
FREEDLE, LARRY
LEDBETTER, DENNIS
BACHMAN, EDDIE
NAPIER,LONNIE
REAGAN,PETE
DOSS,MARION
•
REGULAR Year To Date
MO BENEFIT REG BENEFIT FED. TAX ST. TAX
80.00
2,290.35
400.00
2,816.02
1,547 82
75,694.94
0.00
0.00 300.00
0.00
0.00
0.00
0.00 200.00
0.00' 7,084.22
25.00
1,465.00
NET
80.00
1,990.35
400.00
0.00
2,816.02
1,322.82
67,145.72
NEW BENEFITS
3,492.86
3,455.40
2,396.34
3,219.73
3,235.68
4,920.63
WE, THE UNDERSIGNED, DO SOLEMNLY SWEAR THAT THE ABOVE OBLIGATIONS ARE
JUST AND CORRECT. THAT NO PART THEREOF HAS BEEN PREVIOUSLY PAID; THAT
THE PENSION PAYMENTS SO CHARGED ARE IN ACCORDANCE WITH THE ACTIONS OF
THE BOARD OF TRUSTEES OF THE FIREMEN'S RELIEF AND PENSION FUND; THAT
THE SERVICES OR SUPPLIES FURNISHED, AS THE CASE MAY BE, WERE ACTUALLY
RENDERED OR FURNISHED; AND THAT THE CHARGES MADE THEREFORE DO NOT
EXCEED THE AMOUNT ALLOWED BY LAW OR THE CUSTOMARY CHARGE FOR SIMILAR
SERVICES OR SUPPLIES
TARP
ACKNOWLEDGEMENT
CHAIRMAN AND PRESIDENT
STATE OF ARKANSAS)
COUNTY OF WASHINGTON)
SWORN TO AND1SUBSCRIBED BEFORE ME THIS DAY OF , 2003.
NOTARY PUBLIC
MY COMMISSION EXPIRES : •
YTD
6810-9810-5335-00 0.00
•
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FAYETTEVILLE FIREMEN'S PENSION AND RELIEF FUND
DEFERRED RETIREMENT OPTION PLAN (DROP)
MEMBER ELECTION FORM (Beneficiary Designation)
(.0 -zea -5/3-/7-8755
Member SSN
S6i3 40Y! bee - i
Address
use
Years of Service
City
<13� 35-v•2 lo_-2/-IQle0
/-/7-fqe,d
DOB
72727
Zip
SSN DOB
77ece_i- 30 I 8
Date of Empl yment Witness
l,1A,._4
Date
1
l°1/4/02-
ESIGNATION
F BENEFICIARY
I hereby designate the following . eneficiary t receive any benefits from the DROP plan if I die
prior to my termination of emplo ent:
(: e J� Relationship
p
Signature o et er Date n
�,,{
Please select one of the following (if .pouse is n t selected as beneficiary): V lY
I certify that to best of my larn ' wledge, the above-named member
is single or that his spouse 01 not be located.
Signature of Plan Rep ntative/Notary Date
I certify
above-named benefi
beneficiary, I will
•
•
t I have agreed with my spou e on the selection of the
or beneficiaries. I understan• that if I am not named
t be entitled to benefits under the P
Signature of S'' se Dat
I certify that I ave witnessed the above spouse's signature...
Signature o Plan Representative/Notary Date
•
FAYETTEVILLE FIREMEN'S PENSION AND RELIEF FUND
DEFERRED RETIREMENT OPTION PLAN (DROP)
MEMBER ELECTION FORM
I hereby elect the DROP as my retirement benefit option from the pension plan in place of
normal retirement benefit. I understand that in electing DROP, I have agreed to thefollowing
statements:
1. The amount of the DROP payments will be $375/ f per month. This
amount includes all service and age 60 bonuses that I ave earned to this date.
This amou is the same as if I retired today.
2. I understan that the monthly benefit that I receive at the end of the
DROP period is e exact same amount stated in I m 1, regardless of any pay
raises I receive or xtra years of service I may wo k.
3. I understand that a the end of the DROP
receive the DROP acco t as a lump sum or c
monthly annuity account o any other method o
current Rules and Regulatio of DROP.
4. I understand that the DRO account will remain in the pension fund until
withdrawn in accordance with the ules and ulations of the DROP plan. I do
not have the ability to withdraw f m the OP account until the time of my
departure.
5. I have elected to begin the DROP on '� tu4 / a OO 3 . DROP will
end at the earlier of when I resign or ) , rte" , (5 years from
the above date, unless authorizations to - to in DROP shall be specifically
extended by the Arkansas Statutes).
od I will have the option to.
nvert the DROP account to a
payment as provided for in the
6. I understand that neither the pens
tax advice concerning the way the
consult, my own tax advisor for thi
fund nor
ROP accoun
information.
1
e Department has given any
is taxed. I have, or will
7. I have read the Rules and Reg ations pertaining to ROP.
'Two exceptions to these rules: Age 60 bonuses (.r members with over 25 years o service when they go on to DROP)
begin - age 60 whether still o cROOP or not; ses given to retirees are also given DROP participants.
r
' i
sj
S use Signature
ember
Plan Representative
Date
Date.
1
Date
xo
•
4
I M P O R T A N T NOTICE
Attorneys for the Fayetteville Fireman's Pension and Relief
Fund Board of Trustees has advised that there may be serious•
potential tax consequences as a result of participating in the
Deferred Retirement Option Plan (DROP, A.C.A.§24-11-830) as
follows:
AN APPLICATION
FEFERRAL STATUS OF THE OF
FIREMAN'S DETERMINATION IEF
PENSION AND REL
TAX D
FUND PLAN AND TRUST HAS NEVER BEEN FILED WITH THE IRS.
ALSO, NO DETERMINATION REQUEST BAS BEEN MADE FOR THE
DEFERRED RETIREMENT OPTION PLAN (DROP), 'AN AMENDMENT TO
THE PENSION AND RELIEF FUND PLAN AND TRUST. RELIANCE ON
ANOTHER STATE'S QUALIFICATION IS NOT PERMITTED. AN
ADVERSE RULING ON THE.TAX DEFERRED STATUS OF THE PLAN
COULD HAVE SERIOUS DETRIMENTAL TAX CONSEQUENCES TO EACH
PARTICIPANT DROP DISTRIBUTIONS WILL BE TREATED AS
ORDINARY INCOME IN THE YEAR CONSTRUCTIVE RECEIPT OCCURS
AND ROLLOVER INTO AN OTHERWISE QUALIFIED PLAN, IRA OR
OTHER INVESTMENT MAY NOT BE POSSIBLE. BY NOT ACTING TO
FORMALLY TAX QUALIFY THE PLAN, AN ARRAY OF POSSIBLE
OPTIONS FOR THE DROP PARTICIPANTS MAY NOT BE AVAILABLE.
We strongly urge you to seek advice from a competent tax
accountant and/or attorney before participating in the DROP
program. You assume the risk of such adverse tax consequences if
you elect to participate.
Aa?3
49;
0/147-
4970
44970
7o2 44 775-
PoWed 573/A2
(7))4/50 7,d'
37_51A5
•
GENERAL FIRE PENSION
Prepared:
Name: Teddy Oneal Date of Retirement:
Emp # 94
SS# 432-13-8755
DOH: 3/30/1981
Yrs Srv: 21
•
Hourly Rate: 15.046
Hours Base: 3,272 00
EMT/Hazmat Pay: 520.00
Annual Salary 49;750.51
Annual Benefit (at 90% of salary) 44,775.46
1\12 of Annual Benefit 3,731 29
Additional yrs beyond 20:
Monthly benefit
Daily benefit
1
$20.00 20.00
3,751 29
123.33
1/22/2003
U1. L•. JJ ♦O. JL
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FAYETTEVILLE FIREMEN'S PENSION AND RELIEF FUND
DEFERRED RETIREMENT OPTION PLAN (DROP)
MEMBER FI PCIION FORM (Beneficiary Designation)
Joey h )(fey,"
Member
/37x4 14-2(je Grv,?..9 A
AddressesL
k' / / P✓_-ty
Spouse
Years of Service
te3a-a9-779.5 7- S9
SSN - DOB
/ jrifC12 P „eir. 7,2753
City State Zip
14a9-55-7337 //-sem
SSN
6- 7- Pat
DOB
Date of Employment Witness Date
DESIGNATION OF BENEFICIARY
I hereby designate the following beneficiary to receive any benefits from the DROP plan if I die
. prior to my teaation of employment:
Signa(tLrq f'Member
Name
Relationship
/3- 03
Date
Please select one of the following (if spouse isnot selected as beneficiary):
I certify that to the best of my knowledge, the above-named member
is single or that his spouse cannot be located.
Signature of Plan Representative/Notary Date
I certify that I have agreed with my spouse on the selection of the
above-named beneficiary or beneficiaries. I understand that if I am not named
beneficiary, I will not be entitled to benefits under the Plan.
Signature of Spouse
I certify that I have witnessed the above spouse's signature.
Date
I Signature of Plan Representative/Notary
Date
•
•
•
FAYETTEVILLE FIREMEN'S PENSION AND RELIEF FUND
DEFERRED RETIREMENT' OPTION PLAN (DROP)
MEMBER ELECTION FORM
I hereby elect the DROP as my retirement benefit option from the pension plan in place of
normal retirement benefit. I understand that in electing DROP, I have agreed to the following
statements:
*
�z �j,
1. The amount of the DROP payments will be $ ?33 r%;1 per month. This
amount includes all service and age 60 bonuses that 1 have earned to this date.
This amount is the same as if I retired today.
* 2. I understand that the monthly benefit that I will receive at the end of the
DROP period is the exact same amount stated in Item 1, regardless of any pay
raises I receive or extra years of service I may work.
3. I understand that at the end of the DROP period I will have the option to
receive the DROP account as a lump sum or convert the DROP account to a
monthly annuity account or any other method of payment as provided for in the
current Rules and Regulations of DROP.
4. I understand that the DROP account will remain in the pension fund until
withdrawn in accordance with the Rules and Regulations of the DROP plan. I do
not have the ability to withdraw from the DROP account until the time of my
departure. }
5. I have elected to begin the DROP on /4-`M i) 1J3 . DROP will
end at the earlier of when I resign or / 2022R' , (5 years from
the above date; unless authorizations to participate inJ
JDROP shall -be specifically
extended by the Arkansas Statutes).
6. I understand that neither the pension fund nor the Department has given any
tax advice concerning the way the DROP account is taxed. I have, or will
consult, my own tax advisor for this information.
7. I have read the Rules and Regulations pertaining to DROP.
*Two exceptions to these rules: Age 60 bonuses (for members with over 25 years of service when they go on to DROP)
begin at age 60 whether still on DROP or not; raises given to retirees are also given to DROP participants.
eller 'gnature ^ Date
Spouse Sig
Date
Plan Representative Date
Vlr
IMPORTANT NOTICE
Attorneys for the Fayetteville Fireman's Pension and Relief
Fund Board of Trustees has Advised that there may be serious
potential tax consequences as a result of participating in the
Deferred Retirement Option Plan (DROP, A.C.A.424-11-830) as
follows:
AN APPLICATION FOR A LETTER OF DETERMINATION AS TO THE
TAX DEFERRAL STATUS OF THE FIREMAN'S PENSION AND RELIEF
FUND PLAN AND TRUST HAS NEVER BEEN FILED WITH THE IRS.
ALSO, NO DETERMINATION REQUEST HAS BEEN MADE FOR THE
DEFERRED RETIREMENT OPTION PLAN (DROP), AN AMENDMENT TO
THE PENSION AND. RELIEF FUND PLAN AND TRUST. RELIANCE ON
ANOTHER STATE'S QUALIFICATION IS NOT PERMITTED. AN
ADVERSE RULING ON THE TAX .DEFERRED STATUS OF THE PLAN
COULD. HAVE SERIOUS DETRIMENTAL TAX CONSEQUENCES TO EACH
PARTICIPANT. DROP DISTRIBUTIONS WILL BE TREATED AS
ORDINARY INCOME IN THE YEAR CONSTRUCTIVE RECEIPT OCCURS
AND ROLLOVER INTO AN OTHERWISE QUALIFIED PLAN,
OR
OTHER INVESTMENT MAY NOT BE POSSIBLE. BY NOT ACTING TO
FORMALLY TAX QUALIFY THE PLAN, AN ARRAY OF POSSIBLE
OPTIONS FOR THE DROP PARTICIPANTS MAY NOT BE AVAILABLE.
we strongly urge you to' -seek advice from a competent tax
accountant and/or attorney before participating in the DROP
program. You assume the risk of such adverse tax consequences if
you elect to participate.
GENERAL FIRE PENSION
Prepared:
Name: Joey Pierce Date of Retirement:
Emp # 112
SS# 432-29-7295
DOH: 6/7/1982
Yrs Srv: 20
Ned
Hourly Rate:
Hours Base:
EMT/Hazmat Pay:
13.601
3,272 00
Annual Salary 44,502.47
Annual Benefit (at 90% of salary) 40,052.22
1\12 of Annual Benefit 3,337.69
Additional yrs beyond 20:
$20.00 .0.00
Monthly benefit 3,337.69.
Daily benefit 109.73
1/22/2003
V A . 4.1. V
1 V • uU
V1 u01 A.'•
FAYETTEVILLE FIREMEN'S PENSION AND RELIEF FUND
DEFERRED RETIREMENT OPTION PLAN (DROP)
MEMBER ELECTION FORM (Beneficiary Designation)
Glen L. shtcklarol'iloISS
Member SSN DOB
1033 l S. LI) h i-$-€4buSd- F -ta I �12 /270 I
Address City 1State Zip
eturnlyrlSha,Cke,lon1 51 N-bo--iosq Jl/ig1.5i1
Spouse SSN DOB
Years of Service Date of EmploymentWitness / !date //20/0.3
DESIGNATION OF BENEFICIARY
I hereby designate the following beneficiary to receive any benefits from the DROP plan if I die
prior to my termination of employment:
CPT ro\ of Szsk_(c t;l-cut'a
Name Relationship
Signature of Member
I -/S-03
Dale/
al X23 -D3
Please select one of the following ('f spouse is not selected as beneficiary):
I certify that to the best of my knowledge, the above-named member
is single or that his spouse cannot be located.
Signature of Plan Representative/Notary • Date
I certify that I have agreed with my spouse on the selection of the
above-named beneficiary or beneficiaries. I understand. that if I am not named
beneficiary, I.will not be entitled to benefits under the Plan.
Signature of Spouse . Date
I certify that I have witnessed the above spouse's signature.
Signature. of Plan Representative/Notary Date
FAYETTEVILLE FIREMEN'S PENSION AND RELIEF FUND
DEFERRED RETIREMENT OPTION PLAN (DROP)
MEMBER ELECTION FORM
•
I hereby elect the DROP as my retirement benefit option from the pension plan in place of
normal retirement benefit. I understand that in electing DROP, I have agreed to the following
statements:
* 1. The amount of the DROP payments will be $3337,6 per month. This
amount includes all service and age 60 bonuses that I have earned to this date.
This amount is the same as if I retired today.
* 2. I understand that the monthly benefit that I will receive at the end of the
DROP period is the exact same amount stated in Item 1, regardless of any pay
raises I receive or extra years of service I may work.
3. I understand that at the end of the DROP period I will have the option to
receive the DROP account as a lump sum or convert the DROP account to a
monthly annuity account or any other method of payment as provided for in the
current Rules and Regulations of DROP.
4. I understand that the DROP account will remain in the pension fund until
withdrawn in accordance with the Rules and Regulations of the DROP plan. I do
not have the ability to withdraw from the DROP account until the time of my
departure.
5. I have elected to begin the DROP on 0/(14e % 2,00p3 . DROP will
end at the earlier of when I resign or /1 .3038) , (5 years from
the above date, unless authorizations to participate in DROP shallbe specifically
extended by the Arkansas Statutes).
6. I understand that neither the pension fund nor the Department has given any
tax advice concerning the way the DROP account is taxed. I have, or will
consult, my own tax advisor for this information.
7. I have read the Rules and Regulations pertaining to DROP.
*Two exceptions to these rules: Age 60 bonuses (for members with over 25 years of service when they go on to DROP)
begin at age 60 whether still on DROP or not; raises given to retirees are also given to DROP participants.
3
Member Signature Date
�`� 1113103
Spouse Sig ttre Date
Plan Representative Date
L s -.. tot,
IMPORTANT NOTICE
Attorneys for the Fayetteville Fireman's Pension and Relief
Fund Board of Trustees has advised that there may be serious
potential tax consequences as a result of participating in the
Deferred Retirement Option Plan (DROP, A.C.A.424-11-830) as
follows:
AN APPLICATION FOR A LETTER OF DETERMINATION AS TO THE
TAX DEFERRAL STATUS OF THE FIREMAN'S PENSION AND RELIEF
FUND PLAN AND TRUST HAS NEVER BEEN FILED WITH THE IRS -
ALSO , NO DETERMINATION REQUEST HAS BEEN MADE FOR THE
DEFERRED RETIREMENT OPTION PLAN (DROP), AN AMENDMENT TO
THE PENSION AND RELIEF FUND PLAN AND TRUST. RELIANCE ON
ANOTHER STATE'S QUALIFICATION IS NOT PERMITTED. AN
ADVERSE RULING ON THE TAX DEFERRED STATUS OF .THE PLAN
COULD HAVE SERIOUS DETRIMENTAL TAX CONSEQUENCES TO EACH
PARTICIPANT. DROP DISTRIBUTIONS WILL BE TREATED AS
ORDINARY INCOME IN THE YEAR CONSTRUCTIVE RECEIPT OCCURS
AND ROLLOVER INTO AN OTHERWISE QUALIFIED PLAN, IRA OR
OTHER INVESTMENT MAY NOT BE POSSIBLE. BY NOT ACTING TO
FORMALLY TAX QUALIFY THE PLAN, AN ARRAY OF POSSIBLE
OPTIONS FOR THE DROP PARTICIPANTS MAY NOT BE AVAILABLE.
We strongly urge you .to seek advice from a competent tax
accountant and/or attorney before participating in the DROP
program. You assume the risk of such adverse tax consequences if
you elect to participate.
14562 •
3337, �s
Name:
Emp #
SS#
DOH:
Yrs Sly:�
Glenn Shackelford
110
432-15-6985
5/3/1982
20
Hourly Rate:
Hours Base:
EMT/Hazmat Pay
GENERAL FIRE PENSION
Prepared:
Date of Retirement:
13.601
3,272.00
Annual Salary.
Annual Benefit (at 90% of salary)
1\12 of Annual Benefit
Additional .yrs beyond 20:
Monthly benefit
Daily benefit
44, 502.47
40, 052.22
3,337.69
$20.00 0.00
3,337.69
109.73
1/22/2003
•
Owe 4.
FAYETTEVII.LE FIREMEN'S PENSION AND RELIEF FUND
DEFERRED. RETIREMENT OPTION PLAN (DROP)
MEMBER ELECTION FORM (Beneficiary Designation)
N\ P2S\ir la\ \ E . � SSS -civ -3be ( 01 f 0
Member SSN - DOB
zz S.Vico 1kt+N0
Address
ci>94
Spouse (ca i r�
- -D �c...4\as -
Years of Service
�
P s -rpt , AXk-rti�Ss 1 x-130
City State Zip
3.q - og — L133la 031 ')-�-4 S �
SSN DOB
ti%�- G � /A
Date of Employment Witness Date
DESIGNATION OF BENEFICIARY
I hereby designate the following beneficiary to receive any benefits from the DROP plan if I die
prior to my termination of employment:
Ce.Q,,i S . Mn aD
Name
Signature of Member Dat
Please select one of the following (if spouse is not selected as beneficiary):
I certify that to the best of my knowledge, the above-named member
CPO C
Relationship
22`
is single or that his spouse cannotbe located.
Signature of Plan Representative/Notary Date
I certify that I have agreed with my spouse on the selection of the
above-named beneficiary or beneficiaries. I understand that if I am not named
beneficiary, I will not be entitled to benefits under the Plan.
Signature of Spouse Date
I certify that I have witnessed the above spouse's signature.
•
Signature of Plan Representative/Notary Date
C
•
•
FAYETTEVILLE FIREMEN'S PENSION AND RELIEF FUND
DEFERRED RETIREMENT OPTION PLAN (DROP)
MEMBER ELECTION FORM
I hereby elect the DROP as my retirement benefit option from the pension plan in place of
normal retirement benefit. I understand that in electing DROP, I have agreed to the following
statements: 3 73/-47 6
* 1. The amount of the DROP payments will be $ % per month. This
amount includes all service and age 60 bonuses that I have earned to this date.
This amount is the same as if I retired today.
* 2. I understand that the monthly benefit that I will receive at the end of the
DROP period is the exact same amount stated in Item 1, regardless of any pay
raises I receive or extra years of service I may work.
3. I understand that at the end of the DROP period I will have the option to
receive the DROP account as a lump sum or convert the DROP account to a
monthly annuity account or any other method of payment as provided for in the
current Rules and Regulations of DROP.
4. I understand that the DROP account will remain in the pension fund until
withdrawn in accordance with the Rules and Regulations of the DROP plan. I do
not have the ability to withdraw from the DROP account until the time of my
departure. ., `
5. I have elected to begin the DROP on �1 1�3 . DROP will
end at the earlier of when I resign or 'W1 u `7S , (5 years from
the above date, unless authorizations to participate in DROP shall be specifically
extended by the Arkansas Statutes).
6. I understand that neither the pension fund nor the Department has given any
tax advice concerning the way the DROP account is taxed. I have, or will
consult, my own tax advisor for this information.
7. I have read the Rules and Regulations pertaining to DROP.
'Two exceptions to these rules: Age 60 bonuses (for members with over 25 years of service when they goon to DROP)
begin at age 60 whether still on DROP or not; raises given to retirees are also given to DROP participants.
cMember Sig rey. Date
SpouseSignature _ Date
Plan Representative Date
IMPORTANTYID
NOTICE
Attorneys for the Fayetteville Fireman's Pension and Relief
Fund Board of Trustees has advised that there may be serious
potential tax consequences as a result of participating in the
Deferred Retirement Option Plan (DROP, A.C.A.424-11-830) as
follows:
AN APPLICATION FOR A LETTER OF DETERMINATION AS TO THE
TAX DEFERRAL. STATUS OF THE FIREMAN'S PENSION AND RELIEF
FUND PLAN AND TRUST HAS NEVER BEEN FILED WITH. THE IRS.
ALSO, NO DETERMINATION REQUEST HAS BEEN MADE FOR THE
DEFERRED RETIREMENT OPTION PLAN (DROP), AN AMENDMENT TO
THE PENSION ANOTHER STATE'SD RELIEF QUALIFICATPION IS AND
ST. PERMITTEDNCE ON
N
ADVERSE RULING ON THE TAX DEFERRED STATUS OF .THE PLAN
COPARTICIPANT. PANT. HAVE DROP OUS DETRIMENTAL
S�rUTIO S WILL IommEs TO EACH
BE TREATED AS
ORDINARY INCOME IN THE YEAR CONSTRUCTIVE RECEIPT OCCURS
AND ROLLOVER INTO AN OTHERWISE QUALIFIED PLAN, IRA OR
OTHER INVESTMENT
POSSIBLE. BY IOT A
CTING TO
FORMALLY QUALIFY THE PLAN, AN ARRAYOF POSSIBLE
OPTIONS FOR THE DROP. PARTICIPANTS MAY NOT BE AVAILABLE.
We strongly urge you to seek advice from a competent tax
accountant and/or attorney before participating in the DROP
program. You assume the risk of such adverse tax consequences if
you elect to participate.
•
(416446 ytb
423)
- 5
g1Z6,-775
GENERAL FIRE PENSION
Prepared:
Name: Marshall Mahan Date of Retirement:
Emp# 111
SS# 555-90-3666
DOH: 6/1/1982
Yrs Srv: 20
0�
Hourly Rate: 15.046
Hours Base: 3,272 00
EMT/Hazmat Pay: 520.00
Annual Salary 49,750.51
Annual Benefit (at 90% of salary) 44,775.46
1\12 of Annual Benefit 3,731 29
Additional yrs beyond 20:
Monthly benefit
Daily benefit
$20.00 0.00
3,731.29
122.67
1/22/2003